Ablation treatment of bone metastases

• US 6,478,793 B1
• Filed: 06/01/2000
• Issued: 11/12/2002
• Est. Priority Date: 06/11/1999
• Status: Expired due to Term

• Current Assignee: Covidien AG (Medtronic Plc)
• Original Assignee: Sherwood Services AG
• Inventors: Cosman, Eric R., Rittman, William
• Primary Examiner(s): Peffley, Michael
• Assistant Examiner(s): Ruddy, David M.
• Application Number:
  US09/584,877
• Time in Patent Office: 894 Days
• Field of Search: 606/34, 606/27-29, 606/41, 606/42, 606/46, 607/101, 607/154, 128/898
• US Class Current: 606/34
• CPC Class Codes: A61B 18/1477 Needle-like probes
• CPC Class Codes: A61B 2017/00694 with means correcting for movement of or for synchronisation with the body
• CPC Class Codes: A61B 2018/00023 closed, i.e. without wound contact by the fluid
• CPC Class Codes: A61B 2018/00208 actively driven, e.g. by a motor
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/1861 with an instrument inserted into a body lumen or cavity, e.g. a catheter
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/2055 Optical tracking systems
• CPC Class Codes: A61B 2034/2072 Reference field transducer attached to an instrument or patient
• CPC Class Codes: A61B 2090/365 augmented reality, i.e. correlating a live optical image with another image
• CPC Class Codes: A61B 2090/376 using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 34/25 User interfaces for surgical systems

Abstract

Ablative treatment of metastatic bone tumors and relief of pain associated with metastatic bone tumors is achieved by heat ablation of the bone tumor or tissue near the bone tumor by an ablation probe. In one form the probe is an electrode coupled to a high frequency power supply to provide ablative heating of tissue proximate to an electrode that is placed in or near the bone tumor. Cooling of the electrode by fluid circulation from a cooling apparatus outside the patient'"'"'s body may be used to enlarge the region of high frequency heating around the electrode. Image guidance of the electrode placement may be monitored by an imaging device. Tracking of the electrode by an image-guided navigator helps in placement of the electrode with respect to the configuration of the bone and bone metastasis. A set of tools accommodates biopsy and various shapes of electrodes according to clinical requirements. Several forms of electrodes, energy delivery and cooling apparatus and methods accommodate the specific objectives.

Claims

1. A method of treating a bone tumor comprising the steps of:

advancing a pointed electrode to a target treatment site, the electrode having a pointed tip and a partially non-planar side surface section adjacent a distal end thereof, to facilitate penetration of bone;

rotating the electrode during the advancing step such that the partially non-planar side surface advances the electrode through tissue;

imaging the electrode tip to confirm placement at the target treatment site;

applying energy to the electrode to ablate tissue at the target site; and

cooling tissue by selectively circulating cooling fluid through the electrode.

2. The method according to claim 1 wherein the cooling step includes circulating coolant fluid through fluid input and output channels formed in the electrode.

3. The method according to claim 1 wherein the step of rotating the electrode includes turning a hub formed on the proximal end of the electrode with a driver.

4. The method according to claim 1 wherein the step of rotating the electrode includes turning a hub formed on the proximal end of the electrode with an external motorized driver.

5. The method according to claim 1 wherein the imaging step includes imaging the electrode with an imaging modality selected from the group consisting of MRI, PET, CT, ultrasound, fluoroscopy, and x-ray.

6. The method according to claim 1 wherein the non-planar side surface section includes grooves formed thereon.

7. A method of treating a bone tumor comprising the steps of:

advancing an electrically insulated cannula and stylet assembly to a target treatment site, the stylet having a pointed tip capable of piercing bone and a grooved side surface section near the distal end portion;

rotating the stylet during the advancing step such that the grooved side surface section advances the stylet through tissue;

removing the stylet from the cannula;

inserting an electrode through the cannula to partially extend from the distal end of the cannula into the target treatment site;

imaging the electrode tip to confirm placement at the target treatment site;

applying energy to the electrode to ablate tissue at the target site; and

cooling tissue by selectively circulating cooling fluid through the electrode.

8. The method according to claim 7 wherein the cooling step includes circulating coolant fluid through fluid input and output channels formed in the electrode.

9. The method according to claim 7 wherein the step of rotating the electrode includes turning a hub formed on the proximal end of the electrode with a driver.

10. The method according to claim 7 wherein the step of rotating the stylet includes turning a hub formed on the proximal end of the stylet with an external motorized driver.

11. The method according to claim 7 wherein the imaging step includes imaging the electrode with an imaging modality selected from the group consisting of MRI, PET, CT, ultrasound, fluoroscopy, and x-ray.

12. A minimally invasive method of relieving the local pain of a metastatic bone tumor comprising the steps of:

drilling a cannula with a drilling stylet into bone tissue;

imaging the electrode tip to confirm placement at the target treatment site;

removing the drilling stylet from the cannula;

inserting an electrode into the cannula such that a conductive tip of the electrode emerges from a distal end of the cannula;

heating the bone and surrounding tissue sufficient to denervate nerve cells and reduce local pain at the site; and

cooling tissue immediately adjacent the conductive tip of the electrode by selectively circulating cooling fluid through the electrode.

13. The method according to claim 12 wherein the cooling step includes circulating coolant fluid through fluid input and output channels formed in the electrode.

14. The method according to claim 12 wherein the step of drilling includes turning a hub formed on the proximal end of the electrode with a driver.

15. The method according to claim 12 wherein the imaging step includes imaging the electrode with an imaging modality selected from the group consisting of MRI, PET, CT, ultrasound, fluoroscopy, and x-ray.